Jan Kalvoda, Bohdana Kalvodová (Department of Ophthalmology, Charles University, Prague, Czech Republic), Jaroslava Dušková (Institut of Pathology, Charles University, Prague, Czech Republic)

Advantages:

To evaluate the efficiency of vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with chronic diffuse and/or cystoid diabetic macular edema (DME) and to perform histopathologic and morphometric analysis of the ILM. Thickness of the ILM was correlated with the level of hemoglobin A1C and other clinical factors.

Methods:

The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63 ± 7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in standard way. Mean period of observation of patients after vitrectomy was 8.7 months. The ILM was fixed immediately after peeling in 2.5 % glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed in standard magnification (x 5 000) with the scale of 1 µm in the shot.

Effectiveness / Safety:

Statistical analysis proved general improvement of the postoperative visual acuity (VA) with the prevalence of the resulted VA in intervals 0.1 – 0.2 and 0.5 – 1.0 (related to ETDRS table). Morphometric analysis demonstrated a significant thickening of the ILM in all eyes with a mean thickness of the ILM 3.61 ± 0.91 µm. It was found that a higher thickness of the ILM is related to elevated hemoglobin A1C by both types of diabetes mellitus. Vitrectomy with peeling of the ILM in eyes with chronic DME mildly improves the VA and extends a hope for its stabilization. Morphometric and histopathologic analysis of the ILM contributes to more objective evaluation of ultrastructure of the vitreomacular interface.